July 28, 2021

Covid’s bustin’ out all over. All over the ICU and morgue… I wish I didn’t have to say that but the numbers are soaring locally with Alabama having gone from a couple of hundred daily diagnoses at the beginning on the month to about 1,000 cases a day midmonth to about 32000 cases a day at the end of last week to nearly 3,000 cases a day this week. It’s the power of exponential numbers being manifest in real time. We’re back over 1,000 hospitalized patients statewide, a place we haven’t been at since February, just as the vaccinations were really beginning to gear up and things show no signs of letting up. I haven’t seen the numbers for UAB yet but all the pieces are moving to get the hospital ready for full scale inundation. Elective procedures are beginning to be postponed, drive through testing sites are being ramped back up, and the medicine services are limiting transfers in.

We remain behind the curve as the Delta variant didn’t really start spreading in Alabama until this month. Given the well known delays between diagnoses, hospitalization rates, and death rates, we won’t start to see a major crush on the hospitals for another week or two and the death rates will start going up beginning mid-August. To see where we’re going we just need to look at the Ozark area of Southern Missouri and Northern Arkansas. Delta arrived early via Memorial Day Weekend in Branson. Now, roughly eight weeks later, every hospital in the region is full. I have seen reports from physicians in the area that there are no ICU beds to be had in any of the surrounding states for desperately ill people, and they are significantly short staffed. The current surge is very different from the surges of 2020. Those were based in dense urban environments with large numbers of international travelers – New York, San Francisco, Los Angeles, Seattle. The current surge is hitting small town and rural areas where the infrastructure is nowhere near as robust.

When the numbers really begin to increase in Alabama next month, UAB and Birmingham will be OK. We have a strong medical infrastructure with a number of excellent hospitals. Rural Alabama, with its health care systems already weakened to the point of collapse by the political refusal of successive Republican administrations to take the Medicaid expansion, will not fare so well. I’m not sure that the smaller hospitals that serve a huge portion of the population are going to be able to survive the coming crisis. When they shut their doors due to lack of funds, lack of staff, a crush of patients they are ill equipped to handle, what comes next? When every ICU bed for a hundred miles is occupied by a Covid patient on a ventilator, what happens to the usual parade of heart attacks, strokes, traffic accidents, gunshot victims and all of the other things that arrive seeking acute care on a daily basis?

This is what infuriates me about the coordinated political push to undermine vaccines which has been conducted through certain media outlets since the change in administration. It’s not just about you and your personal choice. It’s about a health care system that was just beginning to recover from crisis that’s slipping back into it. It’s about the callous disregard for the toll that a preventable illness is going to exact not just on you but on the people who care for you, physically and emotionally. It’s about the denial of a more open life to the part of society that stepped up, washed their hands, masked up, social distanced, and got their vaccines – all tried and true public health measures – and whose hard work is being undone by people who somehow believe that viral illness works along partisan lines. Given the infectiousness of the Delta variant and the way exponential math works, it’s entirely possible that the vast majority of the 100 million or so American adults without vaccines will be exposed to it in the next two or three months. That’s another 500,000-1,500,000 unnecessary deaths that could be coming by the end of the year.

I’m tired of writing about Covid. I really am. It’s been over sixteen months now since the first entry in what became the Accidental Plague Diaries. I would love to write more about theater and travel and interesting people and reminiscences and art but every time I think I’m out, I get pulled back in again by a story that, as of yet, has no end. It seems to have become my place in life to chronicle all of this so that I and those of you who didn’t give up three paragraphs ago can continue to process the ongoing saga. So, I will continue to write. For those interested, I have seen the final page proofs of the book. It looks great. It goes to the publisher tonight for a test printing and, if that looks good, advance copies will follow shortly. A high proportion of Covidiots in my part of the world pretty much guarantees there will be enough material for a second book if I want to go through the agonies of putting it together – but that’s a decision for another day.

In the meantime – back to the litany. Wash your hands. Wear your mask indoors around people you don’t know. Social distance when you can. UAB is going back to indoor masking in all buildings unless in your own office. Get your vaccine. It’s not too late. A pharmacist friend told me that community demand is going back up (three vaccines a day last week, twenty vaccines a day this week) but there’s still plenty to be had.